Tag: lung cancer

More Work Ahead for Chest X-Ray AI?

Posted on by Brian Casey

In another blow to radiology AI, the UK’s national technology assessment agency issued an equivocal report on AI for chest X-ray, stating that more research is needed before the technology can enter routine clinical use.

The report came from the National Institute for Health and Care Excellence (NICE), which assesses new health technologies that have the potential to address unmet NHS needs. 

The NHS sees AI as a potential solution to its challenge of meeting rising demand for imaging services, a dynamic that’s leading to long wait times for exams. 

But at least some corners of the UK health establishment have concerns about whether AI for chest X-ray is ready for prime time. 

  • The NICE report states that – despite the unmet need for quicker chest X-ray reporting – there is insufficient evidence to support the technology, and as such it’s not possible to assess its clinical and cost benefits. And it said there is “no evidence” on the accuracy of AI-assisted clinician review compared to clinicians working alone.

As such, the use of AI for chest X-ray in the NHS should be limited to research, with the following additional recommendations …

  • Centers already using AI software to review chest X-rays may continue to do so, but only as part of an evaluation framework and alongside clinician review
  • Purchase of chest X-ray AI software should be made through corporate, research, or non-core NHS funding
  • More research is needed on AI’s impact on a number of outcomes, such as CT referrals, healthcare costs and resource use, review and reporting time, and diagnostic accuracy when used alongside clinician review

The NICE report listed 14 commercially available chest X-ray algorithms that need more research, and it recommended prospective studies to address gaps in evidence. AI developers will be responsible for performing these studies.

The Takeaway

Taken with last week’s disappointing news on AI for radiology, the NICE report is a wakeup call for what had been one of the most promising clinical use cases for AI. The NHS had been seen as a leader in spearheading clinical adoption of AI; for chest X-ray, clinicians in the UK may have to wait just a bit longer.

CT Detects Early Lung Cancer

Posted on by Brian Casey

A massive CT lung cancer screening program launched in Taiwan has been effective in detecting early lung cancer. Research presented at this week’s World Conference on Lung Cancer (WCLC) in Singapore offers more support for lung screening, which has seen the lowest uptake of the major population-based screening programs. 

Previous randomized clinical trials like the National Lung Screening Trial and the NELSON study have shown that LDCT lung cancer screening can reduce lung cancer mortality by at least 20%. But screening adherence rates remain low, ranging from the upper single digits to as high as 21% in a recent US study. 

Meanwhile, lung cancer remains the leading cause of cancer death worldwide. To reduce this burden, Taiwan in July 2022 launched the Lung Cancer Early Detection Program, which offers biennial screening nationwide to people at high risk of lung cancer.

The Taiwan program differs from screening programs in the US and South Korea by including family history of lung cancer in the eligibility criteria, rather than just focusing on people who smoke. 

Researchers at WCLC 2023 presented the first preliminary results from the program, covering almost 50k individuals screened from July 2022 to June 2023; 29k had a family history of lung cancer and 19k were people who smoked heavily. Researchers found …

  • 4.4k individuals receive a positive screening result for a positive rate of 9.2%
  • 531 people were diagnosed with lung cancer for a detection rate of 1.1%
  • 85% of cancers were diagnosed at an early stage, either stage 0 or stage 1

This last finding is perhaps the most significant, as part of the reason for lung cancer’s high mortality rate is that it’s often discovered at a late stage, when it’s far more difficult to treat. As such, lung cancer’s five-year survival rate is about 25% – far lower than breast cancer at 91%.

The Takeaway

Taiwan is setting an example to other countries for how to conduct a nationwide LDCT lung cancer screening program, even as some critics take aim at population-based screening. Taiwan’s approach is broader and more proactive than that of the US, for example, which has erected screening barriers like shared decision-making.

Although it’s still early days for the Taiwan program, future results will be examined closely to determine screening’s impact on lung cancer mortality – and respond to screening’s critics.

Value of Cancer Screening

Posted on by Brian Casey

A new study claims that medical screening for diseases like breast and cervical cancer has saved lives and generated value of at least $7.5T (yes, trillion) over the last 25 years. The findings, published in BMC Health Services Research, are a stunning rebuke to critics of screening exams.

While the vast majority of doctors and public health officials support evidence-based screening, a vocal minority of skeptics continues to raise questions about screening’s efficacy. These critics emphasize the “harms” of screening, such as overdiagnosis and patient anxiety – an accusation often levied against breast screening. 

Screening’s critics also target the downstream costs of medical tests intended to confirm suspicious findings. They argue that a single screen-detected finding can lead to a cascade of additional healthcare spending that drives up medical costs.

But the new study offers a counter-argument, putting a dollar figure on how much screening exams have saved by detecting disease earlier, when it can be treated more effectively. 

The research focused on the four main cancer screening tests – breast, cervical, colon, and lung cancer – analyzing the impact of preventive screening on life-years saved and its economic impact from 1996 to 2020, finding …

  • Americans enjoyed at least 12M more years of life thanks to cancer screening
  • The economic value of these life-years added up to at least $7.5T
  • If everyone who qualified for screening exams got them, it would save at least another 3.3M life-years and $1.7T in economic impact
  • Cervical cancer screening had by far the biggest economic impact ($5.2T-$5.7T), followed by breast ($0.8T-$1.9T), colorectal ($0.4T-$1T), and finally lung ($40B). 

Lung cancer’s paltry value was due to a small eligible population and low screening adherence rates. This finding is underscored by a new article in STAT that ponders why CT lung cancer screening rates are so low, with one observer calling it the “redheaded stepchild” of screening tests.  

The Takeaway
Screening skeptics have been taking it on the chin lately (witness the USPSTF’s U-turn on mammography for younger women) and the new findings will be another blow. We may continue to see a dribble of papers on the “harms” of overdiagnosis, but the momentum is definitely shifting in screening’s favor – to the benefit of patients.

Is There Hope for CT Lung Screening?

Posted on by Brian Casey

New data on CT lung cancer screening rates offer a good news/bad news story. The bad news is that only 21.2% of eligible individuals in four US states got screened, far lower than other exams like breast or colon screening.

The good news is that, as low as the rate was relative to other tests, 21.2% is still much higher than previous estimates. And the study itself found that the rate of CT lung screening has risen over 8 percentage points in 3 years. 

Compliance has lagged with CT lung screening ever since Medicare approved payments for the exam in 2015. A recent JACR study found that screening rates were low for eligible people for both Medicare and commercial insurance (3.4% and 1.8%).

Why is screening compliance so low? Explanations have ranged from fatalism among people who smoke to reimbursement requirements for “shared decision-making,” which unlike other screening exams require patients and providers to discuss CT lung screening before an exam can be ordered.

In this new study in JAMA Network Open, researchers examined screening rates in four states – Maine, Michigan, New Jersey, and Rhode Island – from January 2021 to January 2022. The study drew data from the National Health Interview Survey and weighted it to reflect the population of the US of individuals eligible for CT lung screening, based on the criteria of ages 55-79, 30-pack-year smoking history, and having smoked or quit within the past 15 years. Major findings included: 

  • The rate for CT lung cancer screening was 21.2%, up from 12.8% in 2019
  • People with a primary health professional (PHP) were nearly 6 times more likely to get screened (OR=5.62)
  • The age sweet spot for screening was 65-77, with lower odds for those 55-64 (OR=0.43) and 78-79 (OR=0.17)
  • Rates varied between states, with Rhode Island having the highest rate (30.3%) and New Jersey the lowest (17.5%).
  • Of those who got screened, 27.7% were in poor health and 4.5% had no health insurance

The Takeaway

The findings offer some hope for CT lung screening, as the compliance rate is among the highest we’ve seen among recent research studies. On the other hand, many of those screened were in such poor health they might not benefit from treatment. The high rate of compliance in people with PHPs indicates that promoting screening with these providers could pay off, especially given the requirement for shared decision-making. 

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